| The Application of Stereotactic Spinal Radiosurgery for Spinal Tumors Using Novalis Shaped Beam Radiosurgical Unit |
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Moon-Jun Sohn, Dong Joon Lee, Hye Ran Lee, Yoon Joon Hwang, Ji Yoon Ryoo, Sang Ryong Jeon, Ho Yeon Lee, Sang Ho Lee, C Jin Whang |
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Department of Neurosurgery, Internal Medicine, Radiology, and Thoracic and Cardiovascular Surgery, Clinical Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Korea Department of Neurosurgery, Asan Medical Center, Ulsan University, College of Medicine, Seoul, Korea Department of Neurosurgery, Wooridul General Hospital, Seoul, Korea |
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| Abstract |
Objective
s: Recent advances in image guided navigation and radiosurgical technologies has enabled spinal stereotactic radiosurgery to be practicable. Providing the applicable and high accuracy radiosurgical technique for treating spinal tumors, ultimately
we are to contribute to improve the quality of life in spinal tumor patients. The goal of this study is to evaluate the early clinical results
of spinal radiosurgery for the spinal tumors and to establish optimal dose fraction regimens and cord tolerance to the irradiation.
Methods
Using Novalis shaped beam radiosurgical unit, total 52 lesions of spinal tumors were treated. To improve reposition
accuracy and localization, thermoplastic head and neck mask system and optic guided tracking system were used in combination
with stereotactic body frame (Exactrac®
) & immobilization device. For improving image quality and optimal dose planning, image
fusion method was used, a so-called“segmental fusion method”, to precisely correlate the MR image to the CT image. Intensity
modulated radiosurgery (IMRS) was used to minimize the spinal cord irradiation. Considering spinal cord tolerance,“inverse
planning technique”was used to escalate radiation dose to the lesions.
Results
Mean planning target volume (PTV) of benign and metastatic tumor was 3.54cm3
vs. 25.26cm3
, respectively. 5 lesions
had undergone conventional radiotherapy prior to radiosurgery. Mean prescribed dose of the lesion was 12.8 vs. 25.8Gy at 80%
isodose line in 1.7 vs. 2.9 fractions (benign vs. metastasis, mean). Spinal cord irradiation more than 6Gy was 0.12cm3
vs. 0.32cm3
(benign vs. metastasis, mean). The pain related to metastatic lesions markedly improved within two weeks. Most of the tumors
were stable or reducing in their volume during follow-up periods.
Conclusion
Spinal radiosurgery is effective and safe treatment modality for spinal tumors using image-guided technology and
non-invasive stereotactic system. |
| Key Words:
Image guided stereotaxis, Spinal radiosurgery, Novalis shaped beam surgery, Spinal tumors. |
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